If your chiropractic or medical practice treats auto accident patients, you are the opponent in a zero-sum game which the auto insurance industry as a whole has adopted as its injury claims handling model. Insurers “win” the game by disputing the legitimacy of every non-life-threatening injury suffered in a car crash. The strategy is simple: devalue the injury claim by attacking the credibility of doctors whose records are being used to support the severity of the injury.
The most prominent purveyors of this scheme – State Farm, Allstate and GEICO – implement the strategy by filing federal “fraud” lawsuits premised on an allegation of supposed “predetermined treatment protocols.”
The genesis, development, and deployment of the bogus predetermined treatment protocol accusation has been detailed in prior articles. In short, though, the accusation exploits racial and economic stereotypes about auto accident claimants and personal injury lawyers, which stereotypes the insurance industry itself has spent hundreds of millions of dollars to manufacture. These stereotypes and the prejudices they create are the unspoken undercurrent of the lawsuits, which inflict crippling legal expense and public scorn by design. Countless medical providers across the country have been ruined by this mercenary profit scheme, which has enabled insurers to avoid billions of dollars in claims payments they were otherwise fully obligated to make.
This “fraud” strategy against doctors has been so notoriously successful that insurers have recently resorted to merely threatening a federal fraud lawsuit, knowing the notoriousness of the threat alone is enough to cower a medical provider into submission. Companies such as Allstate, State Farm, and GEICO employ dedicated “fraud” lawyers to send a letter directly to a targeted doctor which generically states that the company has developed some unnamed “concern” about the doctor’s billing or treatment and would like to sit down with the doctor to “resolve” it.
But no matter how seemingly innocuous such a “Dear Doctor” letter is designed to appear, make no mistake, it is an overt threat of litigation. In fact, by the time a doctor receives one of these letters, the doctor is effectively already in litigation.
THE KEYSER SOZE EFFECT
In the 1995 movie The Usual Suspects, the specter of an unimaginably cruel and vicious underworld figure named Keyser Soze drives the plot. Soze is an omnipresent but never seen menace whose mere mention terrifies hardened criminals and cops alike into risking everything they hold dear just to avoid him showing up.
But of course, at the end of the movie, the audience learns that whatever Keyser Soze’s actual dangerousness might ever have been, he was by then just a Boogey-man story told by bad people looking to scare others into doing their bidding.
It is this “Keyser Soze Effect” which State Farm, Allstate, GEICO and others increasingly count on when sending a letter to doctors announcing some unidentified “concern” about the doctor’s billing or treatment requiring “resolution”. The unspoken but very clear threat is of a torturous federal fraud lawsuit showing up if the “concern” is not “resolved.”
But this demanded “resolution” is basically extortion and is always the same: Pay hundreds of thousands of dollars; waive all rights to be paid in any pending claims; and agree not to submit any bills to the insurer for years if not forever.
The good news is, just like Keyser Soze is really just a scare tactic to the uninitiated, the threat of a fraud lawsuit by an insurer these days has been exposed as nothing to be reacted to out of fear.
This is because an accusation of “predetermined treatment” is based on nothing more than statistical cherry-picking of past medical records and is easily exposed as meaningless. Where patients have suffered the same basic mechanism of injury (auto accident), to the most commonly injured area of the body in auto accidents (neck and back), and sought treatment with a specialist focusing on such injuries, statistical similarities in their treatment and billing codes should always be discernible.
State Farm, Allstate, GEICO, and the others all know this, which is why they resort to the Keyser Soze Effect. They know they do not really have a legitimate lawsuit to bring, but they also know that the mere fear of such a suit can extort the “settlement” their bottom-line demands.
DO NOT REACT IN FEAR
Although the fear intended by insurers is unwarranted, immediate and decisive preemptive action is necessary to neutralize the threat being made by a “Dear Doctor” letter. After all, the mere fact that a lawsuit is baseless has never stopped any insurer from filing it where the legal expense and reputational damage of being accused, even falsely, can help tilt the score of the zero-sum game in their favor.
One such action which Baratta Law has recently litigated to great success in multiple states is a preemptive Declaratory Judgment lawsuit which demands that the insurer justify the scientific legitimacy of using “patterns” across past records to characterize treatment to one patient as somehow illegitimate. Insurers have no such ability, so as long as a targeted doctor can get into court first, the insurer will have no choice but to abandon its extortion plot rather than have it exposed.
It is therefore critical that upon receipt of a “Dear Doctor” letter from lawyers representing the likes of State Farm, Allstate, or GEICO alleging supposed “concerns” about billing, the targeted doctor immediately contact counsel experienced in such matters. You must put yourself in a position of strength before responding to prevent being taken advantage of.
If you have received a “Dear Doctor” letter or are otherwise being targeted by a false accusation of fraud in the treatment of injured accident victims, please feel free to contact me directly at email@example.com or 215-914-8132.